Last Wednesday, 05/26/2022, the National Supplementary Health Agency (ANS) set the maximum percentage of annual readjustment for individual and family health plans at 15.5%.
The 2022 increase rate is the highest in the last 20 years and should impact about 8 million beneficiaries, according to a survey carried out by ANS. It is worth remembering that, in 2021, for the first time in history, this same index was negative (-8.19%), which resulted in a reduction in monthly fees.
The significant discrepancy in the percentages set for the years 2021 (-8.19%) and 2022 (15.5%) reflects the atypical movements of the health plan sector, caused by the Covid-19 pandemic, since in one year there was a reduction and in the other year there was a growing resumption of the use of medical and hospital services by the beneficiaries.
Despite the high percentage approved by the ANS, it is important to emphasize that there is no irregularity or illegality in the increase in tuition fees.
Law No. 9,656/98, which deals with private health care plans and insurance, authorizes two types of increases: annual adjustment due to cost variation and adjustment due to age group variation of the beneficiary.
The percentage increase released in the last week, of 15.5%, refers to the annual adjustment for the period of May 2022 and April 2023 and can be applied from the contract anniversary date (month of contracting the plan ), exclusively for regulated individual and family health plans (contracted as of January 1999 or adapted to Law No. 9,656/98).
In this context, it is important to clarify that the ANS does not determine the annual increase rate at random. The percentage is obtained through calculation, the methodology of which is the result of studies and research carried out over several years and based on the variation of medical expenses and an inflation index.
The calculation combines the Value Index of Assistance Expenses (IVDA) with the Broad Consumer Price Index (IPCA), removing the Health Plan sub-item from the latter, thus reflecting both the variation in expenses with assistance to beneficiaries and non-assistance costs, such as administrative expenses.
Although it weighs on the consumer's pocket, the monthly adjustment, both annual and by age range, is extremely necessary to maintain the financial balance of the sector. If it were not possible to update the value of the monthly fees of the health plans, based on the variation in the costs of medical-hospital procedures, it would be impossible for the plans to maintain the provision of contracted services.
Finally, it should be noted that the percentage disclosed year by year by ANS is not applicable to old plans, contracted before January 1999. For these plans, the adjustment rules established in the contractual instrument apply.
For information related to the type of plan contracted and applicable readjustment rules, the consumer can consult the ANS website, which provides service channels.
Bruna Silva Franceschi,
